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0City of Santa Ana <br />Clerk of the Council <br />AGREEMENT TERMINATION FORM <br />Please complete this form in its entirety when the attached dgte9 eVarf a?:150 <br />amendments (if any) are no longer in effect. <br />Note: If your agreement is grant related, please ensure that all grant retention t' I �pts; <br />have been satisfied prior to signing the termination form- o y'-% Uf COUNOiL <br />Is the agreement(s) a permanent record? Yes No <br />Return form to the Clerk of the Council Office (M-30). <br />Call 647-1520 if you have any questions. <br />The agreement with A <br />No. A-a--o/7-- a�Lfd was completed on <br />(List all amendments. Use space below If needed.) <br />COTC Office Use Only <br />�� �� ✓ and final payment has been made. <br />Department: ��y � Aj <br />Phone/Ext.: <br />Signature: f U< (9-8kta— <br />Date: <br />Revised: 10-1 B-16 <br />